Healthcare Provider Details

I. General information

NPI: 1508231788
Provider Name (Legal Business Name): VICTOR V KUTSAR DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2015
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3611 MAIN ST STE 103
KANSAS CITY MO
64111-1932
US

IV. Provider business mailing address

524 SE 14TH AVE
PORTLAND OR
97214-2428
US

V. Phone/Fax

Practice location:
  • Phone: 816-561-7035
  • Fax: 816-203-4819
Mailing address:
  • Phone: 971-544-7058
  • Fax: 971-244-9058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6238
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number21766
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2023049802
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: